New Device Helps Parents of Children with Diabetes Sleep Easier

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An under-the-skin sensor connected wirelessly to a bedside computer could prevent dangerously low blood sugar in people with diabetes.

Parents of children with type 1 diabetes may soon be able to sleep
more soundly, thanks to new research aimed at predicting and preventing
dangerously low blood sugar levels at night.

The system, described in the May issue of Diabetes Care,
involves a glucose sensor worn under the skin and an insulin pump
connected to a computer near the bed. The pump delivers
insulin through a catheter inserted under the skin.

The heart of
the system is a specially designed computer algorithm that carefully
monitors blood glucose levels, looking for signs of a possible drop. If
it detects one, it responds by shutting off the delivery of insulin
until levels start to rise again.

"A system like this should
dramatically decrease diabetics' risk of having a seizure overnight,"
said Dr. Bruce Buckingham, professor of pediatric endocrinology at
Stanford, who led the trial and is a co-author of the study, in a press
release. "Patients and parents will be able to have a better night's
sleep, knowing that there is a much lower risk of severe hypoglycemia at
night."

Reductions in Dangerous Low Blood Sugar Levels

During
the day, people with type 1 diabetes usually notice the warning signs
of low blood sugar and can reduce the delivery of insulin accordingly.
However, these signs can be missed while they are asleep. Seventy-five
percent of diabetic seizures—caused by severe low blood sugar, or
hypoglycemia—occur at night. Nighttime hypoglycemia may also be the
cause of 6 percent of deaths in people with diabetes who are younger than 40.

Previous
attempts at alerting diabetics while they slept included glucose
sensors that triggered an alarm when levels dropped too low. However,
people often slept through the alarms. Because the new system is fully
automated, it works while people are asleep.

The system was tested
on 45 people, between the ages of 15 and 45, with type 1 diabetes.
Researchers monitored each person for 42 nights. For some people, the
computer based insulin delivery on the algorithm; the other group
received a steadier stream of insulin through the night (this is how
insulin is typically delivered to people with diabetes when they are
asleep).

On treatment nights, the algorithm looked for signs that
blood sugar levels would drop below 80 milligrams per deciliter within
the next 30 minutes, slightly above the 70 milligrams per deciliter
level that many guidelines deem low blood sugar or hypoglycemia.

With
the algorithm controlling the delivery of insulin, people spent 81
percent less time with low blood glucose while they slept. In addition,
the new method reduced the time spent in low blood glucose episodes by
74 percent.

People also experienced small overall increases in
blood glucose levels, although this still fell within a safe range. To
confirm that this wasn’t an issue, the researchers analyzed the
patient’s ketone levels—a measure of high glucose levels in the
blood—and found that they were similar to the levels of people in the
control group.

More Sound Sleep for Parents of Children with Diabetes

According to the American Diabetes Association, about 1 in every 400 children and adolescents has diabetes.
Parents who help children monitor their blood glucose levels must walk a
fine line between levels that are too high—which can increase the risk
of complications such as diabetic coma—and levels that are too low.

"A
lot of parents whose children have diabetes are getting up night after
night at midnight and 3 a.m. to check their children's blood sugar
levels," said Buckingham. "We think this type of system is going to make
it much easier for them to feel comfortable about letting their child
with diabetes sleep through the night with fewer overnight sugar tests.
Parents will be able to get a better night's sleep, too."

The
researchers are planning on expanding their trials to a larger age
group, including children between the ages of three and 15.